Association of ACA With Young Adult Females Seeking Sexual, Reproductive Health Services

According to data published in JAMA Network Open, the implementation of the 2010 Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE) is associated with a reduction in insurance use for sexual and reproductive health services but an increased use of emergency services in young adult women.

“Insurer billing practices may compromise dependent confidentiality, potentially discouraging dependents from using insurance or obtaining care,” explained Jacqueline E Ellison, PhD, MPH, department of health services, policy, and practice, Brown University School of Public Health, Providence, RI, and colleagues.

Researchers of the cross-sectional study used a difference-in-difference analysis of commercial insurance claims for 4,690,699 individuals from January 1, 2007, through December 31, 2009, and January 1, 2011, through December 31, 2016. The analysis captured insurance use before and after policy implementation among female young adults aged 23 to 25 years (treatment group) who were eligible for dependent coverage compared with those aged 27 to 29 years (comparison group) who were ineligible for dependent coverage.

Results of the analysis show enrollees in the treatment group were less likely to have a comorbidity (77.3% vs 72.9%) and more likely to have a high deductible plan (14.6% vs 10.1%) than enrollees in the comparison group.

“Implementation of the ACA-DCE was associated with a -2.9 (95% CI, -3.4 --2.4) percentage point relative reduction in insurance use for contraception and a -3.4 (95% CI, -3.9 - -3.0) percentage point relative reduction in Papanicolaou testing in the treatment vs comparison groups,” found the researchers.

Additionally, emergency department visits increased 0.4 (95% CI, 0.2-0.7) percentage points and well visits increased 1.7 (95% CI, 1.3-2.1) percentage points.

“The findings suggest that implementation of the ACA-DCE was associated with a reduction in insurance use for sexual and reproductive health services and an increase in emergency department and well health visits by female young adults newly eligible for parental coverage,” concluded researchers. “Some young people who gained coverage under the expansion may not be using essential, confidential services.” —Edan Stanley